Focused Critical Care Billing Education and Feedback as Part of the Emergency Medicine Residency Curriculum Is Effective

BACKGROUND: Emergency medicine physician compensation models often have a productivity component based on the relative value unit. The primary goal of this study was to determine if implementing critical care billing education through both lectures and individual resident feedback as a formal part of the emergency medicine residency curriculum improved critical care billing among residents. METHODS: This was a prospective, pre and post, educational intervention, cohort study of emergency medicine resident critical care billing in an academic emergency department. The study period was from July 2019 through June 2021. Critical care billing data obtained for the academic year of July 2019 through June 2020 established a baseline of resident critical care billing practices. Beginning in April 2020, monthly emails were sent out to the residents listing their critical care billing percentage for each month. The intervention began in July 2020 with a dedicated critical care billing lecture, which was repeated in October 2020. Average critical care billing percentages were discussed with residents during semi-annual evaluations in December 2020 and May 2021. Critical care billing data obtained for the academic year from July 2020 through June 2021 assessed these interventions. RESULTS: Of 44,438 patients seen by residents in the baseline year of the study from July 2019 through June 2020, an average of 5.16% or 2,456 patients were accurately billed for critical care services by residents. The following academic year, after critical care billing interventions were added to the residency curriculum, the accurately billed critical care rate increased to 10.66%, to 4,304 of the 39,396 patients seen by residents. Patients for whom critical care billing was attempted by residents but criteria were not met decreased slightly over the study period, from 666 or 1.43% patients in the baseline year to 529 or 1.31% patients the following year in a non-statistically significant manner. CONCLUSION: Focused critical care billing educational interventions as part of the emergency medicine residency curriculum improved the accuracy of patient critical care billing.